Pain practice : the official journal of World Institute of Pain
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To evaluate the results of lumbar epiduroscopic adhesiolysis using mechanical methods and a radiofrequency catheter followed by epidural steroid and local anesthetic administration in patients with postoperative fibrosis and persistent or recurrent symptoms. ⋯ Endoscopic adhesiolysis is a potentially useful treatment for the relief of chronic intractable low back and lower limb pain in patients with previous lumbar spine surgery and epidural fibrosis. The use of larger volumes of saline during endoscopy and the employment of radiofrequency for the lysis of epidural adhesions are safe procedures, which may provide an additional benefit to the intervention.
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The Pain Self-Efficacy Questionnaire (PSEQ) is a patient self-reported measurement instrument that evaluates pain self-efficacy beliefs in patients with chronic pain. The measurement properties of the PSEQ have been tested in its original and translated versions, showing satisfactory results for validity and reliability. The aims of this study were 2 fold as follows: (1) to translate the PSEQ into Italian through a process of cross-cultural adaptation, (2) to test the measurement properties of the Italian PSEQ (PSEQ-I). ⋯ The PSEQ-I displayed a high construct validity by meeting more than 75% of a priori hypotheses on correlations with measurement instruments assessing pain intensity, disability, anxiety, depression, pain catastrophizing, fear of movement, and coping strategies. Additionally, the PSEQ-I differentiated patients taking pain medication or not. The results of this study suggest that the PSEQ-I can be used as a valid and reliable tool in Italian patients with CLBP.
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Patients with sickle-cell disease (SCD) can experience recurrent vaso-occlusive episodes (VOEs), which are associated with severe pain. While opioids are the mainstay of analgesic therapy, in some patients with SCD, increasing opioid use is associated with continued and increasing pain. Dexmedetomidine, an α2 -adrenoreceptor agonist with sedative and analgesic properties, has been increasingly used in the perioperative and intensive care settings and has been shown to reduce opioid requirement and to facilitate opioid weaning. ⋯ Dexmedetomidine infusions that lasted for 3 to 6 days were associated with marked reduction in daily oral morphine-equivalent intake and decreases in pain scores (numeric rating scale). There were no hemodynamic changes that required treatment with vasoactive or anticholinergic agents. These preliminary findings of possible beneficial effects of dexmedetomidine in decreasing opioid requirements support the hypothesis that dexmedetomidine may have a role as a possible analgesic adjuvant to mitigate VOE-associated pain in patients with SCD.
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Observational Study
Acute Back Pain Following Surgery under Spinal Anesthesia.
The purpose of this study was to determine the factors having a role in the occurrence of acute back pain following spinal anesthesia. ⋯ Contrary to the common belief, it is demonstrated in this study that number of lumbar punctures, method of approach and position of the spinal anesthesia, age, sex, surgical position, and the type of the surgery did not correlate with occurrence of acute back pain following spinal anesthesia.
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To describe fear-avoidance beliefs about low back pain (LBP) in a sample of teaching general practitioners (TGPs) and to investigate the impact on following the guidelines for LBP. ⋯ Teaching general practitioners' fear-avoidance beliefs about LBP are lower than previously reported by their GP colleagues but still negatively influence the way they follow guidelines for LBP patients. This may influence the way they teach the management of LBP.